Treatment of Hyperlipidemia from Japanese Evidence

Abstract

The treatment of hyperlipidemia is aimed at preventing cardiovascular disease (CVD) and coronary heart disease (CHD). As the incidence of CHD in Japan is about one-third lower and that of stroke is two-fold higher compared to Western countries, and the doses of lipid-lowering drugs used in foreign randomized controlled clinical trials (RCTs) are much higher than in general use in Japan, it remains unclear whether the results of RCTs conducted in Western countries could be extrapolated to Japanese patients. Recently, two major large-scale, prospective, RCTs in Japanese hypercholesterolmic patients, the Management of Elevated Cholesterol in the Primary Prevention of Adult Japanese (MEGA) study and the Japan EPA Lipid Intervention Study (JELIS), have been reported. Japanese epidemiological studies and Japanese clinical studies are reviewed. The evidence suggests that hypercholesterolemia, hypertriglyceridemia, and low HDL-cholesterol are strongly associated with increased CHD risk. Lipid-lowering medication shows beneficial effects even in low-risk populations; however, the data did not support that lower cholesterol is better. The safety and efficacy of hyperlipidemia treatment in Japanese patients are discussed.

Dose-finding study of luseogliflozin in Japanese patients with type 2 diabetes mellitus: a 12-week, randomized, double-blind, placebo-controlled, phase II study

“…The median triglyceride level decreased in all of the luseogliflozin groups. Because low HDL-C and hypertriglyceridemia are associated with increased risk of coronary heart disease 23 , the improvements in plasma lipids during treatment with luseogliflozin are expected to be beneficial for patients with T2DM, although these effects need to be confirmed in a longer study.…”

Highly Purified Eicosapentaenoic Acid Treatment Improves Nonalcoholic Steatohepatitis

“…18 Recently, it has also been reported that treatment with n-3 PUFA, a mixture of EPA and docosahexaenoic acid, ameliorates hepatic steatosis and necroinflammation in humans 19 and rats, 20 probably due to a reduction of hepatic tumor necrosis factor (TNF)-α expression and improvement of insulin sensitivity. However, the efficacy of single treatment of EPA for NASH patients has not yet been elucidated.…”

Effects of Eicosapentaenoic Acid on Endothelial Cell-Derived Microparticles, Angiopoietins and Adiponectin in Patients with Type 2 Diabetes

“…The mechanisms of these actions are thought to include inhibition of platelet aggregation and improvement of blood rheologic properties 24) . In addition, some effects of EPA on serum lipids have been reported, as well as a unique preventive effect against atherosclerotic disease and coronary events [25][26][27] ; however, the influence of EPA on EDMPs, Ang-2 and adiponectin in diabetic patients is poorly understood. In the present study, we investigated the effect of EPA on EDMPs, Ang-2 and adiponectin in type 2 diabetes, focusing on the anti-thrombogenic and anti-atherosclerotic properties of EPA.…”